Trends in Medicaid Prices, Market Share, and Spending on Long-Acting Insulins, 2006-2018
This study uses Medicaid drug utilization data to describe reimbursement and market share of long-acting insulins before and after approval of new insulin products and to estimate savings associated with a “biosimilar” for insulin glargine approved in 2015. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

A Man With Headache, Fever, and Neck Stiffness
A 53-year-old man with a history of pseudogout and receiving immunosuppressives after renal transplant had 2 weeks of stiff neck, headache, and fevers and 3 days of right knee pain and swelling with nuchal rigidity, a positive Kernig sign, no focal neurologic deficits, and a right knee effusion on examination. Blood and CSF cultures were negative, WBC count was high normal, and cervical MRI showed degenerative changes with periodontoid calcifications and reactive marrow. What is the diagnosis and what would you do next? (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Canada ’s Amendment to Patented Drug Price Regulation
This Viewpoint reviews proposed changes to regulations governing Canada ’s Patented Medicine Process Review Board, a group mandated by Canada’s government to ensure manufacturers do not charge excessive drug prices, including use of cost-utility analyses to define excessive pricing, revision of reference country comparisons, and reducing regulatory burdens for gener ic drugs. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Management of Small Kidney Tumors in 2019
This JAMA Insights Clinical Update reviews the diagnosis and treatment options for small kidney tumors including active surveillance, biopsy, radical nephrectomy, and nephron-sparing treatments (partial nephrectomy and percutaneous ablation). (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Quick Uptakes: Chemicals in Consumer Products Associated With Early Puberty
This Medical News article discusses prenatal and peripubertal exposures to phthalates, parabens, and phenols and associations with puberty timing. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

A Recent Study Linked Diet Soda With Stroke —But Is It Correlation or Causation?
This Medical News article is an interview with Yasmin Mossavar-Rahmani, PhD, RD, who studied the association of artificially sweetened beverages with cardiovascular disease and mortality in women. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Numerical Errors and Addition of a Sentence
This article was corrected online. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Error in the Introduction
This article has been corrected online. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Data Error
This article has been corrected online. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Statutory Restrictions on Advance Care Planning and Pregnancy
Honoring a person ’s wishes at the end of life is widely recognized as profoundly important to humane, ethical care. To that end, efforts to help individuals make their preferences about end-of-life care known have involved advance care planning, including the completion of advance directives and identification of a surrogate decision maker. Yet, in many jurisdictions in the United States, one condition invalidates a patient’s wishes or efforts on the part of surrogates to honor them: pregnancy. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Lowering Cost and Increasing Access to Drugs Without Hurting Innovation
US drug costs have reached unacceptable and unsustainable levels. Evidence shows that “financial toxicity” arising from drug costs and other medical expenses is reducing financial security for many families and prompting difficult choices, as patients defer or forgo therapies they cannot afford. In stark contrast, comparable countries negotiate drug prices and use drugs more effe ctively. Recent data suggest that other high-income countries have an average life expectancy approximately 3 to 5 years longer than that of the United States, which ranks last among high-income countries and is losing ground compared ...
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Addition of an Intimate Partner Violence Intervention to a Nurse Home Visitation Program
Intimate partner violence (IPV) is ubiquitous and its health consequences are well known, but there is limited evidence from randomized trials to support effective interventions to interrupt violence within intimate relationships. In this issue ofJAMA, Jack and colleagues report no additional improvement in quality of life after adding an intensive intervention to address IPV to an already existing nurse home visitation program for pregnant women expecting their first child. The standard program group and the intervention group both demonstrated improvement in the primary outcome, interview-assessed quality of life at base...
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Medicaid Expansion and Birth Outcomes
One of the great successes of the Affordable Care Act has been the expansion of Medicaid. In large part due to this expansion, the number of individuals in the United States with health care coverage has increased by about 25 to 30 million since 2011; following midterm elections, it is likely that additional Medicaid expansion will occur. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

A Tribute to Douglas G. Altman, DSc
I met Doug Altman 30 years ago at the first Peer Review Congress. Over the next 28 years, Doug and his group became the single most prolific contributors to the Congresses and the science of journal publication. The Congresses led Doug to many collaborations. He and Iain Chalmers had collaborated in work on a meta-analysis that was crucial for the foundation of the Cochrane Collaboration in 1993. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

HHS Funds Development of Vaccine Against Marburg Virus
The Biomedical Advanced Research and Development Authority (BARDA), part of the Department of Health and Human Services (HHS), has funded its first vaccine candidate to protect against Marburg virus, for which there currently is no licensed vaccine. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Screening Preteens in the Emergency Department for Suicide Risk
Nearly a third of emergency department (ED) patients aged 10 to 12 years screened positive for suicide risk, a recently publishedstudy by National Institute of Mental Health (NIMH) researchers found. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Free App to Help Patients Ask Appropriate Questions
The Agency for Healthcare Research and Quality (AHRQ) recently launched a free mobileapp to help patients better prepare for medical visits. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Highlights for April 23/30, 2019
(Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Conditions Warranting Requirement of Vaccination
(Hagler et al. v. Lamer et al. (III.), 120 N. E. R. 575) (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

US State Regulation of Decisions for Pregnant Women Without Decisional Capacity
This study characterizes the prevalence and content of US state statutes governing treatment decisions for decisionally incapacitated pregnant women. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Patient-Physician Relationship in the Age of Expanded Access to Information
To the Editor Drs Kilbride and Joffe discussed how expanded access to medical information and services will change the nature of the patient-physician relationship by enhancing patient autonomy and diminishing the physician ’s role as the gatekeeper to medical information, tests, and interventions. They concluded that the physician will cede power to the patient and shift into the role of an advisor with increased focus on downstream care coordination. This characterization is incomplete; increased access to informat ion does not necessarily foster meaningful autonomy or independence. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Post Hoc Bayesian Analyses
To the Editor The article by Dr Goligher and colleagues reported a post hoc Bayesian analysis of a randomized clinical trial assessing the effects of ECMO for ARDS on mortality. The new analysis of the trial evaluated an important clinical issue using an appropriate methodology, but we would like to suggest that this analysis be completed with another tool of Bayesian methods. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Post Hoc Bayesian Analyses
To the Editor Dr Goligher and colleagues used a Bayesian approach to reanalyze the negative ECMO [extracorporeal membrane oxygenation] to Rescue Lung Injury in Severe ARDS [acute respiratory distress syndrome] (EOLIA) trial. I believe this reanalysis is an example of confirmation bias and illustrates the common criticisms of Bayesian methodology. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Additional Approaches to Treatment of Depression
To the Editor Dr Cuijpers provided a succinct summary of the many challenges faced by clinicians in the treatment and management of depression. Although depression is one of the most common psychiatric disorders, it is also one the most challenging to treat. I concur with Cuijpers ’ recommendations for management strategies that optimize what is already known about depression and its treatment and the need for further research on the causes of depression to guide the development of more effective treatments. However, another approach to achieving better treatment outcomes b egins with the recognition that some sympto...
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Additional Approaches to Treatment of Depression
To the Editor In a Viewpoint article, Dr Cuijpers suggested that the priority for improving treatments for depression should be on identifying which patients will respond so that better treatments can be developed. We agree with this call for personalized and precision medicine for depression. However, the author adopted a traditional latent disease model of depression, which is unlikely to accomplish this goal. More specifically, we identify a number of limitations in Cuijpers ’ arguments. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Patient-Physician Relationship in the Age of Expanded Access to Information —Reply
In Reply Dr Weinlander argues that the characterization of the modern patient-physician relationship in our Viewpoint was incomplete. Specifically, he contends that patients ’ decreasing dependence on physicians for access to information and health care resources does not, as we asserted, enhance patient autonomy. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Post Hoc Bayesian Analyses
In Reply Dr Aberegg raises several important issues about our Bayesian reanalysis of the EOLIA trial. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Additional Approaches to Treatment of Depression
In Reply I agree with Dr Carney that focusing on residual and specific symptoms may be another way to improve treatment outcomes, especially because these residual symptoms are one of the best predictors of relapse and recurrent depression. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Rapid Blood Pressure Reduction Safe for Ischemic Stroke
Intensive blood pressure control reduced the risk of intracranial hemorrhage without increasing the risk of death or disability in patients with acute ischemic stroke receiving intravenous thrombolysis, according to atrial published in theLancet. Previous studies raised concern that quickly reducing blood pressure might worsen cerebral ischemia in these patients. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Caring Text Messages for Preventing Suicides
A suicide prevention intervention that supplemented standard care with caring text messages in active-duty military personnel did not reduce the odds of current suicidal ideation or suicide risk incidents, reported astudy inJAMA Psychiatry. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Acupuncture May Reduce Menopausal Symptoms
A brief course of acupuncture may help ease menopausal symptoms and offer a treatment alternative to hormone replacement therapy, suggested astudy in BMJ Open. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Flexible Duty Hours, Sleep, and Patient Outcomes
Patient safety was not compromised in internal medicine residency programs with flexible duty hours, and medical trainees who worked in these programs were no more sleep-deprived than their peers in standard hour programs, reported 2 recent studies in theNew England Journal of Medicine. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Effect of an Intimate Partner Violence Intervention on Maternal Quality of Life
This cluster randomized trial compares the effect of a nurse home visitation program augmented by an intimate partner violence (IPV) intervention vs nurse home visitation alone on quality of life 24 months after delivery among first-time mothers experiencing social and economic disadvantage. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Trends in Sedentary Behavior
This national survey study uses National Health and Nutrition Examination Survey (NHANES) data to describe trends in sedentary behaviors of the adolescent and adult US population, including watching television or videos for 2 or more hours per day, computer use 1 or more hour per day, and total sitting time. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Association of State Medicaid Expansion Status With Low Birth Weight and Preterm Birth
This study uses national health statistics data to evaluate associations between state Medicaid expansion in 2014-2016 and changes in rates of low birth weight and preterm birth, both overall and by race/ethnicity. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Croup
This JAMA Patient Page describes the symptoms, diagnosis, and treatment of croup in children. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

The Suit
A tuberculous woman,alone in a sealed room,splays out acrossa metal bed; (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Attending Patient Funerals —Claiming the Right to Grieve
In this narrative medicine essay a neurointensivist discusses her evolving understanding of her personal and professional responses to patient deaths, the pressures physicians face not to grieve, and the importance of attending patients ’ funerals for bringing closure to relationships with patient families and easing feelings of guilt, sadness, isolation, and denial. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

CONSORT Extension for Reporting Multi-Arm Parallel Group Randomized Trials
This extension of the CONSORT 2010 Statement, a guideline and checklist for reporting parallel group randomized trials, provides updates for the reporting of multi-arm trials to assist evaluations of rigor and reproducibility and enhance understanding of the methodology of trials with more than 2 comparison arms. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

States as Important Laboratories for Federal Prescription Drug Cost-Containment Efforts
This Viewpoint proposes ways states can control the costs of expensive drugs produced by single manufacturers, including importation from other countries, international benchmark pricing, and statewide upper payment limits. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Assessing The Value of Novel Therapies for an Aging Population
This Viewpoint discusses the costs of emerging therapies for conditions prevalent in the US Baby Boomer population now entering old age and proposes principles to ensure the value and accessibility of new expensive drugs including cost-effectiveness (CE) assessments, price-benefit alignment, and incorporation of CE data into clinical practice guidelines. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Trends in Blood Infection Rates
Progress in reducing the rate of serious blood infections in the US has stalled in recent years, according a recent CDCreport. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

Traumatic Brain Injuries Among Youth
Youth sports remain the leading cause of traumatic brain injuries among children and teens, according to a new CDCreport. The report found football, bicycling, basketball, playground activities, and soccer were associated with the most head injuries. (Source: JAMA)
Source: JAMA - April 23, 2019 Category: General Medicine Source Type: research

The Future of the GLP-1 Receptor Agonists
The discovery of the enteric hormone glucagon-like peptide 1 (GLP-1), and subsequent demonstration that its physiologic actions to lower blood glucose levels can be extended to the treatment of type 2 diabetes, have been important therapeutic advances. The approval of exenatide for clinical use in the United States and Europe in 2005 was the first of several GLP-1 receptor agonists (GLP-1RAs) to advance the clinical use of the dual effects of these drugs to lower glycated hemoglobin (HbA1c) and reduce body weight. This introduced a new and needed option to treat patients with diabetes. The actions of the currently availabl...
Source: JAMA - April 16, 2019 Category: General Medicine Source Type: research

Effect of Add-on Oral Semaglutide vs Sitagliptin on HbA 1c in Type 2 Diabetes Uncontrolled With Metformin
This randomized clinical trial compares the effects of 3-, 7-, and 14-mg/d of oral semaglutide vs sitagliptin on glycated hemoglobin in patients with type 2 diabetes uncontrolled with metformin alone or with sulfonylurea. (Source: JAMA)
Source: JAMA - April 16, 2019 Category: General Medicine Source Type: research

Management of Patients With Severe Aortic Stenosis With Transcatheter Valve Replacement
This JAMA Clinical Guidelines Synopsis summarizes the 2017 focused update of the American College of Cardiology/American Heart Association (AHA/ACC) guideline on management of patients with severe aortic stenosis focusing on surgical vs transcatheter valve replacement (TAVR). (Source: JAMA)
Source: JAMA - April 16, 2019 Category: General Medicine Source Type: research

The Uncertain Effect of Financial Incentives to Improve Health Behaviors
Given considerable empirical support for using financial incentives to motivate desired behaviors, this Viewpoint reviews behavioral economics principles and methodological reasons that might explain the absence of an effect of financial rewards on medication adherence and health outcomes in several recent randomized trials. (Source: JAMA)
Source: JAMA - April 16, 2019 Category: General Medicine Source Type: research

Childhood Lead Exposure May Affect Personality, Mental Health in Adulthood
This Medical News feature summarizes a recent study exploring the link between childhood lead exposure and mental health and personality in adulthood. (Source: JAMA)
Source: JAMA - April 16, 2019 Category: General Medicine Source Type: research

Dr Schrier Goes to Congress as Second Woman Physician
This Medical News article is an interview with the first pediatrician and second woman physician to serve in Congress. (Source: JAMA)
Source: JAMA - April 16, 2019 Category: General Medicine Source Type: research